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volume 388 issue 10053 pages 1659-1724

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

Mohammad H Forouzanfar
Ashkan Afshin
Lily T Alexander
H. ROSS ANDERSON
Zulfiqar A. Bhutta
Stan Biryukov
Michael Brauer
Richard Burnett
Kelly Cercy
Fiona J Charlson
Aaron J. Cohen
Lalit Dandona
Kara Estep
Alize J Ferrari
Joseph J Frostad
Nancy Fullman
Peter W. Gething
William W Godwin
Max Griswold
Simon I. Hay
Yohannes Kinfu
Hmwe H Kyu
Heidi J. Larson
Xiaofeng Liang
Stephen S. Lim
Patrick Y. Liu
Alan D. Lopez
Rafael Lozano
Laurie Marczak
George A. Mensah
Ali H. Mokdad
Maziar Moradi-Lakeh
Mohsen Naghavi
Bruce Neal
Marissa B Reitsma
Gregory A. Roth
Joshua A. Salomon
Patrick J Sur
Theo Vos
JOSEPH A. WAGNER
Haidong Wang
Yi Zhao
Maigeng Zhou
Gunn Marit Aasvang
Amanuel Alemu Abajobir
Kalkidan Hassen Abate
Cristiana Abbafati
Kaja M. Abbas
Foad Abd Allah
Abdishakur M. Abdulle
Semaw Ferede Abera
Biju Abraham
Laith J. Abu-Raddad
Gebre Yitayih Abyu
Akindele Olupelumi Adebiyi
Isaac Akinkunmi Adedeji
Zanfina Ademi
Arsène Kouablan Adou
Jose C. Adsuar
Emilie Elisabet Agardh
Arnav Agarwal
Aliasghar Ahmad Kiadaliri
Oluremi N Ajala
Tomi F Akinyemiju
Ziyad Al-Aly
Khurshid Alam
Noore K M Alam
Saleh Fahed Aldhahri
Robert William Aldridge
Zewdie Aderaw Alemu
Raghib Ali
Ala’a Alkerwi
François Alla
Peter Allebeck
Ubai Alsharif
Khalid A Altirkawi
Elena Alvarez Martin
Nelson Alvis-Guzman
Azmeraw T. Amare
Alemayehu Amberbir
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Heresh Amini
Walid Ammar
Stephen Marc Amrock
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Benjamin O Anderson
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REZA ASSADI
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Justin Beardsley
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Bianca Calabria
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Rosario Cárdenas
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Ruben Estanislao Castro
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Jung‐Chen Chang
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Edgar P. Simard
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Abhishek Singh
Jasvinder A Singh
Prashant Kumar Singh
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Chandrashekhar T Sreeramareddy
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Murray B Stein
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Stefanos Tyrovolas
Kingsley N. Ukwaja
Eduardo A Undurraga
Chigozie Jesse Uneke
Olalekan A Uthman
Aaron van Donkelaar
Jim van Os
Yuri Y Varakin
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J Lennert Veerman
Narayanaswamy Venketasubramanian
Francesco S Violante
Stein Emil Vollset
Gregory R. Wagner
Stephen G. Waller
Jian-Li WANG Jian-li
Linhong Wang
Yanping Wang
Scott Weichenthal
Elisabete Weiderpass
ROBERT G. WEINTRAUB
Andrea Werdecker
Ronny Westerman
HARVEY A. WHITEFORD
Tissa Wijeratne
Charles Shey Wiysonge
Charles D.A. Wolfe
Sungho Won
Anthony D Woolf
Mamo Wubshet
Denis Xavier
Gelin Xu
Ajit Kumar Yadav
Bereket Yakob
Ayalnesh Zemene Yalew
Yuichiro Yano
Mehdi Yaseri
Pengpeng Ye
PAUL YIP
Naohiro Yonemoto
Seok Jun Yoon
Mustafa Z. Younis
Chuanhua Yu
Zoubida Zaidi
Maysaa El Sayed Zaki
Zhu Jun
Ben Zipkin
Sanjay Zodpey
Liesl Joanna Zuhlke
Christopher J. L. Murray
Publication typeJournal Article
Publication date2016-10-07
scimago Q1
wos Q1
SJR12.113
CiteScore87.6
Impact factor88.5
ISSN01406736, 1474547X
General Medicine
Abstract
The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context.We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI).Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa.Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.Bill & Melinda Gates Foundation.
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Forouzanfar M. H. et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 // The Lancet. 2016. Vol. 388. No. 10053. pp. 1659-1724.
GOST all authors (up to 50) Copy
Forouzanfar M. H. et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 // The Lancet. 2016. Vol. 388. No. 10053. pp. 1659-1724.
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@article{2016_Forouzanfar,
author = {Mohammad H Forouzanfar and Ashkan Afshin and Lily T Alexander and H. ROSS ANDERSON and Zulfiqar A. Bhutta and Stan Biryukov and Michael Brauer and Richard Burnett and Kelly Cercy and Fiona J Charlson and Aaron J. Cohen and Lalit Dandona and Kara Estep and Alize J Ferrari and Joseph J Frostad and Nancy Fullman and Peter W. Gething and William W Godwin and Max Griswold and Simon I. Hay and Yohannes Kinfu and Hmwe H Kyu and Heidi J. Larson and Xiaofeng Liang and Stephen S. Lim and Patrick Y. Liu and Alan D. Lopez and Rafael Lozano and Laurie Marczak and George A. Mensah and Ali H. Mokdad and Maziar Moradi-Lakeh and Mohsen Naghavi and Bruce Neal and Marissa B Reitsma and Gregory A. Roth and Joshua A. Salomon and Patrick J Sur and Theo Vos and JOSEPH A. WAGNER and Haidong Wang and Yi Zhao and Maigeng Zhou and Gunn Marit Aasvang and Amanuel Alemu Abajobir and Kalkidan Hassen Abate and Cristiana Abbafati and Kaja M. Abbas and Foad Abd Allah and Abdishakur M. Abdulle and others},
title = {Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015},
journal = {The Lancet},
year = {2016},
volume = {388},
publisher = {Elsevier},
month = {oct},
url = {https://doi.org/10.1016/S0140-6736(16)31679-8},
number = {10053},
pages = {1659--1724},
doi = {10.1016/S0140-6736(16)31679-8}
}
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Forouzanfar, Mohammad H., et al. “Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.” The Lancet, vol. 388, no. 10053, Oct. 2016, pp. 1659-1724. https://doi.org/10.1016/S0140-6736(16)31679-8.